- A stoma is a surgically created communication between a hollow viscus and the skin
- Includes a colostomy, ileostomy, urostomy, caecostomy, jejunostomy and gastrostomy
- Functionally they can be end, loop or continent stoma
Positioning
- Away from umbilicus, scars, costal margin and anterior superior iliac spine
- Ensure compatible with the clothing worn by the patient
- Ideally should be marked preoperatively by stoma nurse
Complications
Structural complications
- Necrosis
- Detachment
- Recession
- Stenosis
- Prolapse
- Ulceration
- Parastomal herniation
- Fistula formation
Pictures provided by Mr Richard Morgan, Freemantle Hospital, Western Australia
Picture provided Vikram Kate, Jawaharial Institute for Postgraduate Medical Education and Research,
Pondicherry, India
Functional disorders
- Excess action
- Distal colostomy should produce solid faeces
- Ileostomy will produce 500-700 ml/day of liquid effluent
- If excess output consider
- Inflammatory bowel disease
- Para-intestinal sepsis
- Subacute obstruction
- Reduced action
- Consider simple constipation or obstruction
Bibliography
Chen F, Stuart M.
The morbidity of defunctioning stomata. Aust N Z J Surg 1996;
66: 218-221.
Martin L, Foster G.
Parastomal hernias. Ann R Coll
Surg 1996; 78: 81 - 84.
Nugent K P. Intestinal stomas.
In: Johnson C D, Taylor I eds. Recent advances in Surgery 22.
Churchill Livingstone 1999; 135-146.
Shellito M. Complications of abdominal stoma surgery.
Dis Colon Rectum 1998; 41:
1562-1572. |
